ENT Flashcards
otalgia
+ some children may tug or rub their ear
recent URTI
bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea
acute otitis media
management of acute otitis media
usually conservative - analgesia
in some exceptions/severe cases = amoxicillin is given for 5-7 days
eg if prolonged for 4 days, if immunocompromised or have a lot of systemic symptoms
pain
conductive hearing loss
tinnitus
vertigo
cerumen impaction
management of cerumen impaction
Initial management of earwax includes ear drops for 3–5 days initially, to soften wax.
If symptoms persist, ear irrigation can be considered, providing that there are no contraindications.
Recent viral infection Sudden onset Nausea and vomiting Hearing may be affected vertigo
labyrinthitis
labyrinthitis
antiemetics or antihistamines
prochlorperazine or cyclizine
ear pain, itch, discharge
otoscopy: red, swollen, or eczematous canal
otitis externa
management of otitis externa
topical antibiotic or a combined topical antibiotic with a steroid
ciprofloxacin in diabetics
second line = flucloxacillin
analgesia for any pain
failure to respond to treatment = ENT referral
dizziness triggered by head movement ~10-20
room is spinning around them/still objects moving
associated nausea
Benign paroxysmal peripheral vertigo
diagnosis of BPPV
positive Dix Hallpike manoeuvre - rotatory nystagmus and vertigo)
management of BPPV
epley manoeuvre
betahistine
vestibular rehabilitation (brandt-Daroff exercises)
severe deep otalgia
temporal headaches
purulent otorrhoea
facial palsy
more common in elderly and diabetics
malignant otitis externa
Ix for malignant otitis externa
CT scan
management of malignancy otitis externa
IV Abx = ciprofloxacin
non-resolving otalgia = ENT referral
severe otalgia behind the ear fever swelling and erythema tenderness over the mastoid process external ear protrudes forward
mastoiditis
management of mastoiditis
managed in hospital
usually IV broad spec antibiotics (Cefixime) for 1-2 days and then 1-2 weeks of oral ABx
‘glue ear’
usually 3-6year olds
chronic otitis media
management of chronic otitis media
offer otovent devices
myringotomy and insert grommets
recurrent = adenoidectomy
keratinising epithelium in the middle ear
usually longstanding eustachian tube dysfunction
cholesteatoma
cholesteatoma management
refer to ENT if suspected
vertigo tinnitus sensorineural hearing loss nystagmus usually unilateral aural fullness/pressure
meniere’s disease
management of meniere’s disease
confirm diagnosis at ENT
pt to inform DVLA
acute attacks = buccal/IM prochlorperazine
prevention/prophylaxis = betahistine and vestibular rehabilitation
hearing loss
vertigo
tinnitus
absent corneal reflex
acoustic neuroma
management of acoustic neuroma
ENT referral
Management is with either surgery, radiotherapy or observation.
Ix of choice for acoustic neuroma
MRI of the cerebellopontine angle is the investigation of choice. Audiometry is also important
hearing loss
may have some discharge
recent history of infection or trauma
loud noisy work/concert
perforated TM
management of perforated TM
no treatment is needed in the majority of cases as the tympanic membrane will usually heal 4-6 weeks
myringoplasty may be performed if the tympanic membrane does not heal by itself
advise to keep the ear dry
facial pain - frontal pressure worsens it (leaning forward)
nasal discharge
nasal obstruction/congestion
some may have a low-grade fever and coryzal symptoms
recent infection/cold
acute sinusitis
management of acute sinusitis
analgesia and intranasal decongestants/nasal saline
intranasal corticosteroids if persists for 10days+
severe cases - ABx = phenoxymethyl-penicillin or co-amoxiclav
management of epistaxis
persistence for 10-15mins
first aid measures = sit with torso forward and mouth open whilst pinch cartilaginous area firmly
if unsuccessful consider topical antiseptic = naseptin
if persists for cautery & packing for a visualised anterior nosebleed - anaesthetic spray and packing needed for this
nasal obstruction
rhinorrhea and sneezing
poor sense of smell/taste
more common in men and also in children/elderly
nasal polyps
management of nasal polyps
referral to ENT & topical corticosteroids
sneezing clear nasal discharge bilateral nasal obstruction/congestion post-nasal drip nasal pruritus
allergic rhinitis
management of allergic rhinitis
oral/intranasal antihistamines
intranasal corticosteroids
and general allergen avoidance
facial pain nasal discharge nasal obstruction - mouth breathing post nasal drip - chronic cough usually ongoing for 12 weeks
chronic sinusitis
management of chronic sinusitis
intranasal corticosteroids
nasal irrigation with saline solution
allergen avoidance
otalgia unilateral serous otitis externa nasal obstruction, discharge of epistaxis cranial nerve (3-6) palsies cervical lymphadenopathy
Nasopharyngeal/oral cancers
Ix for Nasopharyngeal/oral cancers
combined CT & MRI
management of Nasopharyngeal/oral cancers
radiotherapy first line
itchy feeling in the the throat, painful/sore and dysphagia
acute pharyngitis
inflamed/swollen/enlarged tonsils white exudate may be seen on the top of tonsils erythematous tonsils enlarged lymph nodes low grade fever dysphagia sore throat
acute tonsillitis
Scoring FEVERpain & Centor criteria for tonsillitis
centor = tonsillar exudate, tender anterior cervical lymphadenopathy, hx of fever and absence of a cough
= 3-4 = 32-56% likely
feverpain = fever >38° purulent exudate acute onset - within 3 days severely inflamed tonsils no cough/coryza
= 4-5 = 62-65% likely
management of tonsilitis
paracetamol/ibuprofen
antibiotics not routinely indicated
if require Abx = penicillin 7-10 day course
or clarithromycin
(systemic upset, unilateral tonsillitis, hx of rheumatic fever, immunocompromised, 3+ on centor score)
acute rapid onset stridor drooling tripod position - leaning forward with neck extended muffled/hoarse voice blue skin/lips
epiglottitis
Ix epiglottitis
thumb print/sign on X-ray
Management of epiglottitis
immediate senior involvement - emergency airway support from anaesthetist
oxygen and IV Abx
severe sore throat pain - lateralises to one side
deviation of uvula to unaffected side
trismus = difficulty opening mouth
reduced neck mobility
hx of tonsillitis
Quinsy/peritonsillar abscess
management of quinsy
urgent review by ENT specialist
needle aspiration/Incision and drainage
IV Abx
potential tonsillectomy to prevent recurrence
plaque like lesion cannot be rubbed away
bright white
sharply defined patches
more common in males and smokers
usually in 50s-70s
oral leukoplakia
Ix/management oral leukoplakia
Biopsies are usually performed to exclude alternative diagnoses
prodromal itching, pain and tingling in the lower mouth
initially vesicles
collapse into ulcers
often manifest as a result of recent illness/under stress, immunocompromised
Oral herpes simplex
management of oral herpes simplex
topical antivirals (aciclovir) use as soon as symptoms begin - usually 5 days
(can also use chlorhexidine mouthwash)
topical pain relief
usually preceding malaise, fever and headaches
can also have myalgia
bilateral swelling of parotid glands - near the ear
parotitis
Ix for parotitis
Salivary IgM against mumps
management of parotitis
mainly supportive - analgesia, fluids and bed rest
Prevention = MMR vaccine
white patches on oral mucosa
can be wiped off - reveals a erythematous/bleeding base
oral candidiasis
management of oral candidiasis
topical fluconazole
advise good oral hygiene
clearly defined, painful, shallow, rounded ulcers
can be caused by trauma, stress, food allergies and hormonal changes
aphthous ulcer
diagnosis of aphthous ulcer
usually diagnosis of exclusion
need to rule out = HSV, carcinoma, IBD or autoimmune disease
management of aphthous ulcer
saline mouthwash
topical corticosteroids
avoid picking
painful enlarged salivary gland
fever
decreased salivary secretion
purulent drainage from duct orifice
sialadenitis
management of sialadenitis
hot/cold compress & massage
aggressive hydration
analgesia
lemon drops = promotes salivation
sore throat
lymphadenopathy in the anterior/posterior triangles)
pyrexia/fever
sore throat/coryza
splenomegaly
hepatitis
palatal petechiae
glandular fever / infectious mononucleosis
diagnosis of glandular fever
maculopapular rash with amoxicillin use monospot test (2nd week of symptoms)
management of glandular fever
conservative management
avoid contact sports for 8 weeks (avoid ruptured spleen)
Pain (toothache) which can quickly become worse. It can be severe and throbbing.
Swelling of the gum, which can be tender.
Swelling of the face
malaise/temperature
dental abscess
management of dental abscess
analgesia
refer to dentist to drain the abscess (lancing)
